Heart failure in Internal Medicine and Cardiology: Epidemiological and clinical characteristics

Abstract

Objectives: The objective of this study was to analyze the epidemiological and clinical differences between patients with heart failure (HF) admitted to an Internal Medicine Department or a Cardiology Department for 5 years. Material and methods: Observational and retrospective analysis of 681 HF patients admitted between January 2007 and December 2011. Patients were divided into two groups: Internal Medicine Group (IMG) and Cardiology Group (CG). We analyzed demographic data, clinic and echocardiography variables. We performed a bivariate statistical analysis, comparing the qualitative variables with Chi-squared test and quantitative variables with Student's t-test. Results: In IMG 489 patients (71.8%) were included versus 192 (28.2%) in CG. In IMG the average age was higher (74 vs 68.5 years-old, p = 0.001) and it had more length of stay (10.8 vs 8.7 days, p = 0.001), ≥2 admissions (42.5 vs 29.7%, p = 0.001) and higher hospital mortality (8.2 vs 1.6%, p < 0.01). In both groups there were a clear male predominance, but not statistically significant. Also, in IMG the patients had more comorbidities: atrial fibrillation (AF) (43.6 vs 30.7%, p = 0.002), chronic obstructive pulmonary disease (COPD) (26.6 vs 10.4%, p < 0.001), chronic kidney disease (CKD) (30.3 vs 19.3%, p < 0.01) and anemia (41.9 vs 33.4%, p < 0.05). On the other hand, the ischemic cardiopathy (IC) (64.4 vs 40.3%, p < 0.001), heart valvulopathy (16.1 vs 8.6%, p < 0.001) and dyslipidemia (49.5 vs 36.6%, p < 0.001) were more common in the CG. Also, in this group, the patients had more systolic dysfunction (average ventricular ejection fraction: 44 vs 52%, p < 0.001) but better functional class (NYHA III or IV: 36.4 vs 50.1%, p < 0.001). High blood pressure (HBP) and diabetes mellitus type 2 (DM-2) were not statistically significant. In addition, the precipitants of heart failure were different in both groups: the CG had more cardiac precipitants (45.3 vs 15.5%, p < 0.001) and in the IMG, infectious precipitants (36.4 vs 10.4%, p < 0.001). Discussion and conclusion: In our study, the HBP, DM-2, AF, IC and anemia were the pathologies most frequently associated with HF. The patients admitted to an Internal Medicine Department are older, had more comorbidities (AF, COPD, CKD and anemia) and worse functional class, so they had higher hospital mortality, longer length of stay and more readmissions. On the other hand, the patients included in the CG had more cardiac precipitants, ischemic cardiopathy and heart valvulopathy with systolic dysfunction, so in this case, the ventricular ejection fraction does not interfere in the heart failure prognosis. Characteristically, in opposite of others studies, the HBP was followed by both, internists and cardiologists, although, the hypertensive cardiopathy was more frequent in IMG.